Healthcare Provider Details

I. General information

NPI: 1720842776
Provider Name (Legal Business Name): ESTELLA PAYNE CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 JEFFERSON ST
GREENFIELD OH
45123-1229
US

IV. Provider business mailing address

84 WALNUT ST
PEEBLES OH
45660-1284
US

V. Phone/Fax

Practice location:
  • Phone: 937-997-3224
  • Fax:
Mailing address:
  • Phone: 740-463-4278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.195834
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: